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S A N J Q A Q U I N Environimenial Health Department <br /> -COUNTY <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45'F(if food is used the following day, maintain below 41aF temperature): <br /> ❑ Ice chests ❑Refrigerator <br /> ❑Refrigerated truck ❑ Ice bath and tubs <br /> ❑Other(specify) <br /> i 1. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> ❑ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> solution(one tablespoon of bleach per gallon of water), <br /> ❑Detergent,bleach,and wiping cloths(cleaning towels). <br /> ❑Tub to store wiping cloths in bleach solution. <br /> 12. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> DllW�ter supply dispenser with warm water at a minimum of 100`F(i.e.5-20 gallon containerwith spigot). <br /> 9-6ne separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> gaper towels and pump-style soap container. <br /> 13. f—�1�,es of responsible persons to be present in booth during all'hours of operation: <br /> _/• [ Lam.-�M rl S [7 L�Tom_, L_ vr,e s , a <br /> -Important All food vendor booths are subject to inspection. Please make a copy of this application in <br /> preparation for this event. A copy of this checklist must be in the booth at all hours of <br /> preparation and operation. Return original to festival coordinator three weeks prior to <br /> thi event. <br /> 14. Completed by: �- <br /> 519nature Title bate <br /> 5-20 Gel. <br /> Health Permit F1ntl`�ra`'lW-l`� <br /> STM4,"rhaKrr <br /> PaW l hnt TM el: <br /> Sazp dspenau <br /> Cutnnp Boat $an5ver Lucke', <br /> Bent+ YC.I.- <br /> Prapaia$[dV2 Blraah stoingv Pq Cosa <br /> Booth .or bean <br /> 0 Concrete,Asphatl, <br /> Plywood,or a Tarp. <br /> Pr�a:ve lank <br /> $aap antl vaaler Ri.to lValer Jlezch er.'.1M1a:t <br /> Garbage <br /> Can <br /> R ra EAlnplzl eu <br /> E[I!a <br /> Wale <br /> Ice Cooler r-— .._ . ----- II SGal Hand was5 —/ <br /> Er4a lte 8aa�6Faovl Conlanon muse en 1 W,=lewale,Con!a�Tlcr <br /> -- --- aloud 6lnchas arc of lhn gmurrdl <br /> 1868 E.Mazelton Avenue j Stockton, California 952051 T 209 468-3420 l F 209 464-0138 l vrvnv.sjcehd.com <br /> EHO 1 G-02 Page S or 11 TEMP EVENT APP <br /> C713M 7 <br />